| Objective: To explore the relationship between the air pollutants exposure with adverse pregnancy outcomes such as birth defects, premature birth and low birth weight; to provide scientific basis for proper intervention strategies to adverse pregnancy outcomes.Methods:1. The prevalence and the rank of birth defects, the urban-rural differences and sex differences in the prevalence of birth defects were analyzed on the base of birth defects monitoring data of Hainan province during2000～2010. The methods of Poisson-regression and Linear Chi-Square tests were used respectively to compare the differences in the prevalence of birth defects between male and female infants, urban and rural areas and the tendency of birth defects prevalence in Hainan province during the past11years according to the data from the monitoring program of birth defects in Hainan province. T-test and logistic regression was used to analyze the association between air pollutant exposure and birth defects.2. Generalized Additive Model extended Poisson regression model were used to analyze the relationship between air pollutant exposure and premature and low birth weight during2009to2011.Results:1. The prevalence of birth defects in Hainan area from2000-2011was99.13/10000, which was lower than the prevalence of our country. The prevalence of birth defects in urban area was lower than that of rural area (IRR=0.765,95%CI:0.715-0.819, P<0.001); the prevalence of birth defect of male infants was lower than that of female infants (IRR=1.092,95%CI:1.021-1.169, P=0.010); our study showed the birth defects were associated with maternal age:women less than20years old and the age group greater than35had more higher prevalence, there were no difference between the two group(P>0.05), following by age group of20-25(IRR=0.816,95%CI:0.701-0.949, P=0.008), age group of25～30(IRR=0.761,95%CI:0.655-0.883, P<0.001) and age group of30～35(IRR=0.731,95%CI:0.623-0.858, P<0.001);2. Peri-gestational exposure to air pollutants of PM10was associated with birth defects. The multiple logistic regression analysis showed that the effect of PM10on the second month (OR=1.039,95%CI:1.016-1.063, P=0.001) and third month (OR=1.066,95%CI:1.043-1.090, P<0.001) of pregnancy was statistically significant associated with birth defects according to the data from Haikou city. The multiple logistic regression analysis showed that the effect of PM10on the third month (OR=1.025,95%CI:1.006-1.044, P=0.009) of pregnancy was statistically significant associated with birth defects according to the data from Sanya city. The multiple logistic regression analysis showed that the effect of PM10on first trimester was statistically significant with congenital heart diseases (OR=1.103,95%CI:1.023-1.190, P=0.011) according to the data from Haikou city and the effect of studied air pollutants on the cleft lips had no statistical significance.3. Exposure to PM10and SO2was a risk factor of preterm delivery in Haikou city. The results of model fitting with all pollutants showed that on the same day, exposure to PM10was significantly associated with increased risk of preterm delivery (RR=1.016,95%CI:1.003-1.030, P<0.05) and on the cumulative6days, exposure to SO2was significantly associated with increased risk of preterm delivery (RR=1.141,95%CI:1.039-1.242, P<0.05). Exposure to PM10was a risk factor of low birth weight. The results of model fitting with all pollutants showed that on the first day, exposure to PM10was significantly associated with increased risk of low birth weight (RR=1.024,95%CI:1.011-1.038, P<0.05) and on the cumulative6days, was significantly associated with increased risk of low birth weight (RR=1.064,95%CI:1.042-1.087, P<0.05).Conclusions:Exposure to PM10during the early stages of pregnancy was a risk factor of birth defects and congenital heart disease. Exposure to SO2and PM10was associated with preterm delivery. And exposure to PM10during the pregnancy was a risk factor of low birth weight. Primary prevention should be strengthened in order to control and reduce the prevalence of birth defects and adverse pregnancy outcomes, and it is necessary to explore a linkage mechanism between departments of medical health care and environmental protection so as to bring out the full effectiveness of primary prevention. |
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